Review article
The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic

https://doi.org/10.1016/j.msard.2020.102174Get rights and content

Highlights

  • COVID-19 is a pandemic, sometimes fatal disease caused by the SARS-Cov-2 coronavirus.

  • Disease modifying treatments are a perceived risk factor for COVID-19.

  • Immunity eliminates the virus, but in some individuals it causes severe morbidity.

  • The essential immune elements to control MS and the virus may not be the same.

  • Understanding COVID-19 pathobiology and the mechanism of drug action in multiple sclerosis, will help inform choices for treatment

Abstract

Background

SARS-CoV-2 viral infection causes COVID-19 that can result in severe acute respiratory distress syndrome (ARDS), which can cause significant mortality, leading to concern that immunosuppressive treatments for multiple sclerosis and other disorders have significant risks for both infection and ARDS.

Objective

To examine the biology that potentially underpins immunity to the SARS-Cov-2 virus and the immunity-induced pathology related to COVID-19 and determine how this impinges on the use of current disease modifying treatments in multiple sclerosis.

Observations

Although information about the mechanisms of immunity are scant, it appears that monocyte/macrophages and then CD8 T cells are important in eliminating the SARS-CoV-2 virus. This may be facilitated via anti-viral antibody responses that may prevent re-infection. However, viral escape and infection of leucocytes to promote lymphopenia, apparent CD8 T cell exhaustion coupled with a cytokine storm and vascular pathology appears to contribute to the damage in ARDS.

Implications

In contrast to ablative haematopoietic stem cell therapy, most multiple-sclerosis-related disease modifying therapies do not particularly target the innate immune system and few have any major long-term impact on CD8 T cells to limit protection against COVID-19. In addition, few block the formation of immature B cells within lymphoid tissue that will provide antibody-mediated protection from (re)infection. However, adjustments to dosing schedules may help de-risk the chance of infection further and reduce the concerns of people with MS being treated during the COVID-19 pandemic.

Abbreviations

ACE2
angiotensin converting enzyme two
ARDS
acute respiratory distress syndrome
ASC
antibody secreting cells
CNS
central nervous system
DMT
disease modifying therapies
(HSCT)
haematopoietic stem cell therapy
IRT
immune reconstitution therapies
MS
multiple sclerosis
RBD
receptor binding domain
RNA
ribonucleic acid
SARS
Severe acute respiratory syndrome

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